Devices for use in transluminal and endoluminal surgery

ABSTRACT

The present invention is a device and method of using a variety of laparoscopic or NOTES surgical tools at a confined or inaccessible space, e.g., an intra-abdominal surgical and NOTES tool inserted through a single incision through the skin or hollow viscus. Generally, the laparoscopic or NOTES surgical devices include a device body having a first side and a second side, wherein the first side includes a positioning mechanism and the second side includes one or more of a variety of laparoscopic or NOTES tools.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 60/795,923, filed Apr. 29, 2006, the entire contents of which areincorporated herein by reference. This application is related to U.S.patent application Ser. No. 10/999,396, filed Nov. 30, 2004,incorporated herein by reference in its entirety, now U.S. Pat. No.7,429,259, and U.S patent application Ser. No. 12/146,953, filed Jun.26, 2008, which is a Continuation of application Ser. No. 10/999,396.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to an apparatus and system for performingsurgery, and in particular, to tools for hands-free operation andcontrol of medical instruments inside a body cavity.

BACKGROUND OF THE INVENTION

Without limiting the scope of the invention, its background is describedwith respect to surgical procedures, and in particular, laparoscopy andtransmural and endoluminal surgery, e.g., Natural Orifice TransluminalEndoscopic Surgery (NOTES).

Compared with open surgery, laparoscopy results in significantly lesspain, faster convalescence and less morbidity. NOTES, an even lessinvasive surgical approach, is likely to achieve similar results.However, eye-hand dissociation, a two-dimensional field-of-view andinstrumentation with limited degrees of freedom contribute to a steeplearning curve and demanding dexterity requirements for manylaparoscopic and endoscopic procedures. One of the main limitations oflaparoscopy is the fixed working envelope surrounding each trocar, oftennecessitating placement of multiple ports to accommodate changes inposition of the instruments or laparoscope to improve visibility andefficiency. The placement of additional working ports contributes topost-operative pain and carries a small risk of bleeding or adjacentorgan damage.

SUMMARY OF THE INVENTION

The present inventors recognized the need for a system that reduces therequired number of ports of entry during surgery. For endoscopic andNOTES procedures, only one or two accessory instruments can be passedthrough the endoscopic channel. In addition, the flexible endoscope cannot provide desired stiffness when needed. What is needed is a systemthat provides additional tools, increased strength and differentdirectional mechanical force.

In order to provide for greater flexibility in instrument usage and tofurther reduce morbidity, an anchor system and surgical devices or toolsthat can be used in laparoscopic surgery and NOTES have been developedaround an internally positioned surgical device. The various devices arecapable of various laparoscopic and NOTES functions and may be securedto the abdominal wall or hollow viscus via magnetic coupling, suction,mechanical fixation or attached to other devices. For example, thedevices and tools of the present invention may be secured via adetachable pin or needle that crosses into the body cavity and leaves,at most, a very small puncture wound. In addition, the laparoscopicsurgical and NOTES device may include a connection for device removal,electrical power, mechanical power, pneumatic power, optical viewing,lighting and other power. In addition, the laparoscopic surgical andNOTES devices of the present invention may be supported externally tothe surgical device located internally. More particularly, the presentinvention includes a device for manipulating a surgical tool at anintended manipulation location within the body and cavities.

The present invention includes a variety of laparoscopic surgical andNOTES devices that perform numerous functions. For example, the presentinvention includes a variety of tissue and/or organ retractors orclamps, e.g., a suction cup with detachable suction tubing, anactivatable clamp or jaw mechanism, a pin or other device to piercesand/or transfix the tissue, an anchoring system that is deployed withinthe targeted tissue, a T-fastener, a cross, a ring or an inflatableballoon configuration, a suturing type of surgical tool and a clippingtype of surgical tool. Additionally, the surgical device may be acamera, a retractor, a clamp, a paddle, a hose, a cutting tool, a light,a hook, a net or an attachment point to the surgical anchor. Thelaparoscopic surgical and NOTES device may also include a drawstring forremoval.

The present invention provides a laparoscopic surgical and NOTESelectro-cautery device having a device body with a first side and asecond side. The first side includes an anchoring and positioningmechanism and the second side includes an electro-cautery surgicalmechanism.

The present invention also provides a laparoscopic surgical and NOTESretention device having a top surface and a bottom surface. The topsurface includes an anchoring and positioning mechanism and the bottomsurface includes a retention device having one or more movable membersused to grasp an item, object, tool, blood vessel or organ.

A laparoscopic and NOTES device is also provided that includes a topsurface and a bottom surface, with the top surface having an anchoringand positioning mechanism and the bottom surface having a needle with alumen. The needle is positioned in a needle driving device that providesa force to extend the needle and position the needle.

The present invention also includes a laparoscopic surgical and NOTESvacuum cup device having a top surface with an anchoring and positioningmechanism and a bottom surface with a vacuum cup. The vacuum cup islocated on or about a telescopic arm or structure connected to a vacuumcup.

The laparoscopic surgical and NOTES device of the present invention mayinclude ferrous material disposed on, in or about the surgical anchoringand positioning mechanism, or it may even be a wire, wires, a wirebundle and the like and may be, e.g., oriented along the length of thesurgical and NOTES anchor in one or more orientations. The ferrousmaterial of the laparoscopic surgical and NOTES device may be used toattract a magnet positioned externally from the body cavity and hollowviscus, wherein manipulation of the magnet directs movement of thelaparoscopic surgical and NOTES device within the body cavity or viceversa, that is, the surgical anchoring and positioning mechanism ismagnetic and a ferrous material or another magnet is external to thebody cavity and hollow viscus. In one embodiment, the magnet is, e.g., apermanent magnet.

The laparoscopic surgical and NOTES device may further include a ferrousinsert, coating or combination thereof that permits manipulation(position and orientation) of the laparoscopic surgical and NOTES deviceafter insertion without the need for permanent tools or connections. Thelaparoscopic surgical and NOTES device may also include magnets orsuction cups that increase the control for positioning and strengtheningthe attachment in a hands-free system, which may be further augmented bymechanical attachment, e.g., using a locking, detachable pin. One suchpin-anchored system has been developed by the present inventors astaught in U.S. Patent Application US20050165449A1, relevant portionsincorporated herein by reference. After insertion into, e.g., anabdominal cavity and hollow viscus, the surgical and NOTES anchor andtools attached thereto remain surgeon-controlled via, e.g., externalmagnetic couples on the patient's abdomen and outside the hollow viscus.Using the surgical and NOTES system disclosed herein, instruments, e.g.,miniature endoscopic cameras, lights, retractors, scalpels, clamps andthe like may be used to augment, e.g., the surgical field of view,surgical precision and anchoring.

Accordingly, the present inventors have recognized that the field oflaparoscopic surgery and NOTES needs a method and apparatus that enablesa surgeon or an endoscopist to manipulate the position and orientationof one or more instruments within a human body and hollow viscus withoutthe necessity for multiple entry points, trocars, or endoscopes. Toprovide for greater flexibility of endoscopic viewing and instrumentusage and to further reduce morbidity, the inventors have developed anovel laparoscopic and NOTES system that allows for unrestrictedintra-abdominal and intraluminal movement of an endoscopic camera andinstruments without additional port sites and endoscopes.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying figures, in which like reference numerals refer toidentical or functionally-similar elements throughout the separate viewsand which are incorporated in and form part of the specification,further illustrate the present invention and, together with the detaileddescription of the invention, serve to explain the principles of thepresent invention.

FIG. 1 is an isometric view of the laparoscopic and NOTESelectro-cautery surgical device of the present invention;

FIG. 2 is another isometric view of the laparoscopic and NOTESelectro-cautery surgical device of the present invention;

FIG. 3 is another isometric view of the laparoscopic and NOTESelectro-cautery surgical device of the present invention;

FIG. 4 is an isometric view of the laparoscopic and NOTES surgicalretention device of the present invention;

FIG. 5 is another isometric view of the laparoscopic and NOTES surgicalretention device of the present invention;

FIG. 6 is another isometric view of the laparoscopic and NOTES surgicalretention device of the present invention;

FIG. 7 is an isometric view of the laparoscopic and NOTES surgicalneedle device of the present invention;

FIG. 8 is another isometric view of the laparoscopic and NOTES surgicalneedle device of the present invention;

FIG. 9 is another isometric view of the laparoscopic and NOTES surgicalneedle device of the present invention;

FIG. 10 is an isometric view of the laparoscopic and NOTES surgicalvacuum cup device of the present invention;

FIG. 11 is another isometric view of the laparoscopic and NOTES surgicalvacuum cup device of the present invention;

FIG. 12 is another isometric view of the laparoscopic and NOTES surgicalvacuum cup device of the present invention;

FIGS. 13A and 13B are view of a dual external magnet stack in top viewand cross-sectional view respectively; and

FIG. 14 is a cross-sectional view combining the laparoscopic and NOTESsurgical device and the dual external magnet stack for use with thepresent invention.

DETAILED DESCRIPTION OF THE INVENTION

The novel features of the present invention will become apparent tothose of skill in the art upon examination of the following detaileddescription of the invention. It should be understood, however, that thedetailed description of the invention and the specific examplespresented, while indicating certain embodiments of the presentinvention, are provided for illustration purposes only because variouschanges and modifications within the spirit and scope of the inventionwill become apparent to those of skill in the art from the detaileddescription of the invention and claims that follow.

A general description of laparoscopic surgery and NOTES is set forthherein to demonstrate the use of the present invention in one type ofsurgery and is not intended to be exhaustive or to limit the scope ofthe invention. The present invention may include modifications andvariations of each are possible in light of the teachings describedherein without departing from the spirit and scope of the followingclaims. It is contemplated that the use of the present invention caninvolve components having different characteristics. It is intended thatthe scope of the present invention be defined by the claims appendedhereto, giving full cognizance to equivalents in all respects.

As used herein, a “laparoscopic” device refers to any type of surgicaltool that has been reduced in size for entry into a body cavity ororgan. Non-limiting examples of tools that are attached to, or form partof, a laparoscopic device include a camera, a retractor, a clamp, apaddle, a hose, a cutting tool, a light, a hook, a net and an anchorhaving attachment points. Other examples include tissue and/or organretractors or clamps, e.g., a suction cup with detachable suctiontubing; an activatable clamp; a needle or other device to pierces ortransfix a tissue; an anchoring system that is deployed within thetargeted tissue, e.g., a T-fastener, a cross, a ring or an inflatableballoon configuration; a suturing, staple or clipping type of surgicaltool.

As used herein, a “Natural orifice transluminal endoscopic surgery(NOTES)” device refers specifically to any type of tools and devicesthat are used to assist and perform transmural or endoluminal surgery.Non-limiting examples of tools that are attached to, or form part of, aNOTES device include a camera, a retractor, a clamp, a cutting tool, alight, a hook, a net, and an anchor having attachment points. Otherexamples include tissue and/or organ retractors or clamps, e.g., asuction cup with detachable suction tubing; an activatable clamp; aneedle or other device to pierces or transfix a tissue; an anchoringsystem that is deployed within the targeted tissue, e.g., a T-fastener,a cross, a ring or an inflatable balloon configuration; a suturing,staple or clipping type of NOTES tool.

The laparoscopic or NOTES devices may be provided as part of a surgicaltrocar most commonly used in laparoscopic, transluminal and/orendoscopic surgery. For example, prior to use of the trocar, the surgeonmay introduce a Veress needle into the patient's abdominal cavity. TheVeress needle has a stylet, which permits the introduction of gas intothe abdominal cavity. After the Veress needle is properly inserted, itis connected to a gas source and the abdominal cavity is insufflated toan approximate abdominal pressure of, e.g., 15 mm Hg. By insufflatingthe abdominal cavity, pneumoperitoneum is created separating the wall ofthe body cavity from the internal organs.

A trocar with a piercing tip is then used to puncture the body cavity.The piercing tip or obturator of the trocar is inserted through thecannula or sheath and the cannula partially enters the body cavitythrough the incision made by the trocar. The obturator may then beremoved from the cannula and an elongated endoscope or camera may beinserted through the cannula to view the body cavity, or surgicalinstruments may be inserted to perform ligations or other procedures.

A great deal of force is often required to cause the obturator to piercethe wall of the body cavity. When the piercing tip breaks through thecavity wall, resistance to penetration ceases and the tip may reachinternal organs or blood vessels, with resultant lacerations andpotentially serious injury. The creation of the pneumoperitoneumprovides some free space within which the surgeon may stop thepenetration of the trocar. To provide further protection, trocars havemore recently been developed with spring-loaded shields surrounding thepiercing tip of the obturator. Once the piercing tip of the obturatorhas completely pierced the body cavity wall, the resistance of thetissue to the spring-loaded shield is reduced and the shield springsforward into the body cavity and covers the piercing tip. The shieldthereby protects internal body organs and blood vessels from incidentalcontact with the piercing tip and resultant injury.

Once the cannula has been introduced into the opening in the body cavitywall, the pneumoperitoneum may be maintained by introducing gas into theabdominal cavity through the cannula. Various seals and valves have beenused to allow abdominal pressure to be maintained in this fashion.Maintaining abdominal pressure is important both to allow working roomin the body cavity for instruments introduced through the cannula and toprovide free space for the puncturing of the body cavity wall by one ormore additional trocars as may be required for some procedures.

A principal limitation of traditional laparoscopy relates to the fixedworking envelope surrounding each trocar. These relatively small workingenvelopes often necessitate the placement of multiple ports in order toaccommodate necessary changes in instrument position and to improvevisibility and efficiency. The creation of additional ports is known tocontribute to post-operative pain and to increase the risk of bleedingor organ damage. Therefore, the present invention has been developed to:(1) improve the control of tools within a surgical envelope; (2) reducethe number of trocars required (e.g., a single puncture); (3) improvethe working envelope associated with, e.g., laparoscopic surgery; and/or(4) improve instrument positioning, visibility and efficiency.

For NOTES, the insuflation medium is introduced into the hollow viscusand body cavity through an endoscope or an overtube. Principallimitations of traditional endoscopy relate to the limited numbers ofinstruments that can be passed through the endoscopic accessory channel,the lack of trangulation, the lack of visual depth, the lack ofdifferent directional force and the lack of desired stiffness of theendoscope when needed. Therefore, the present invention has beendeveloped to: (1) improve the control of tools within a NOTES platform;(2) increase the number of accessory and tools; (3) improve the workingenvelope associated with, e.g., NOTES; (4) improve instrumentpositioning, visibility and efficiency; (5) provide trangulation anddifferent directional force.

The present invention includes laparoscopic and NOTES surgical devicesthat may be secured to the abdominal wall and hollow viscus andsubsequently positioned using surgeon-controlled magnetic couplers onthe patient's abdomen and hollow viscus. Using the laparoscopic andNOTES surgical devices disclosed herein, in conjunction with thetechniques outlined for magnetic manipulation, laparoscopic and NOTESsurgical devices may be used to augment, aid and perform specific tasksor procedures. The present inventors have evaluated the theoretical andempirical uses of the laparoscopic and NOTES surgical devices andoptimized for size, strength and surgical compatibility, as well as thebenefits, limitations and prospects for the use of incisionless,laparoscopic and NOTES surgical devices in laparoscopic and NOTESsurgery. In one example, the laparoscopic and NOTES surgical devices ofthe present invention will find particular use in single trocar andsingle-incision surgery, which may include transmural delivery thateliminates incisions on the skin. In another example, the presentinvention permits incisions in surfaces with low visibility and deliveryof the laparoscopic and NOTES surgical device or surgical tools to thelocation of the surgery, e.g., trans-umbilical.

Several types and generations of magnetic anchoring schemes andlaparoscopic and NOTES surgical devices have been developed andevaluated. A fundamental design decision arises in generating themagnetic field electrically or via permanently magnetized materials.Electromagnets were initially favored due to: (1) the intrinsic abilityto control the field strength, from zero to a maximum desired value; and(2) high magnetizing forces available in a relatively small footprint.Ex vivo and in vivo studies were used to evaluate the attractive forceneeded for use of electromagnets and permanent magnets. Withelectromagnets it was found that field strength was high at directcontact with the core, however, the field strength across tissuedropped-off drastically over relatively short distances, resulting inrelatively bulky and heavy devices even after optimizing theirlength-to-diameter ratio and winding configuration. It was also foundthat heating caused by resistance limited the useful force attainablefrom an electromagnet due to its effect on skin contact temperature,winding insulation integrity, and surgeon comfort; these drawbacks maybe overcome with active cooling. Given these constraints, permanentmagnets were also investigated and were found to deliver a highercoupling force per unit volume than the basic electromagnetic designs,and can be controlled, when required, by adjusting their distance fromtheir magnetic couple manually or in a closed-loop system. Onelimitation of permanent magnets relative to electromagnets is that thecoupling force is always present, causing attraction to unintendedtargets and thus requiring strict handling procedures in the operatingroom. As such, in some applications electromagnets may be preferred,while in others permanent magnets may be preferred.

Magnetic performance is the result of complex, three-dimensional fieldinteractions governed by material, size, shape, location of magneticpoles and location relative to the target. For this reason, practicaldesign analyses and optimization are tractable only through computersimulation and empirical testing. In arriving at an optimal magneticanchoring system configuration, the main constraint is the size of theintraabdominal couple, which must be designed to fit through thelaparoscopic or NOTES delivery port. The dimensions of the externalanchor are not critical but must be kept as small as practical andergonomically compatible with abdominal laparoscopic and NOTES surgery.

In one non-limiting example, the device has a sufficient coupling force,nominally higher than about 500 grams at a 10 mm gap. The skilledartisan will recognize that the coupling force may be varied dependingon tissue type and thickness, the weight of the device, device materialand device size. In certain examples, two different magnetic anchoringsystems have bee developed. For example, one device used was based on aø9×12 mm internal magnet coupled to a ø25×50 mm external magnet insingle-stack and double stack (side-by-side, 25 mm between centerlines)configurations; all use NdFeB rare-earth magnets. The size, mechanicalstrength and control of these devices may be varied by adding othermechanical or physical control parameters, e.g. pins, suction, graspers,hook-and-loop fasteners and the like.

A wide variety of permanent magnets may be used with the presentinvention, such as rare earth magnets, ceramic magnets, alnico magnets,which may be rigid, semi-rigid or flexible. Flexible magnets are made byimpregnating a flexible material such as neoprene rubber, vinyl,nitrile, nylon or a plastic with a material such as iron having magneticcharacteristics. Other examples of magnets for use as describedhereinabove, include rare earth magnets, e.g., neodymium iron boron(NdFeB) and Samarium Cobalt (SmCo) classes of magnets. Within each ofthese classes are a number of different grades that have a wide range ofproperties and application requirements. Rare earth magnets areavailable in sintered as well as in bonded form.

Ceramic magnets are sintered permanent magnets composed of BariumFerrite (BaO (Fe₂O₃)_(n)) or Strontium Ferrite (SnO(Fe₂O₃)_(n)), where nis a variable quantity of ferrite. Also known as anisotropichexaferrites, this class of magnets is useful due to its good resistanceto demagnetization and its low cost. While ceramic magnets tend to behard and brittle, requiring special machining techniques, these magnetscan be used in magnetic holding devices having very precisespecifications or may be positioned within a protective cover, e.g., aplastic cover. Anisotropic grades are oriented during manufacturing, andmust be magnetized in a specified direction. Ceramic magnets may also beisotropic, and are often more convenient due to their lower cost.Ceramic magnets are useful in a wide range of applications and can bepre-capped or formed for use with the present invention.

In traditional forms of laparoscopic and endoscopic surgery,laparoscopic and endoscopic instruments inserted into a body cavity orhollow viscus are manipulated principally by the application of force tothe portion of the laparoscopic and endoscopic instrument protrudingfrom the patient and integral with a handle. The handle is controlled bythe surgeon and/or endoscopist and requires at all times the instrumentbody being placed through a trocar or other insertion orifice. Althoughthis method is useful for adjusting the depth of insertion of thelaparoscopic and NOTES instrument and can provide a limited range ofangular or side-to-side movement, all but minor changes in theorientation of conventional laparoscopic and NOTES instrument may beaccomplished without the creation of additional incisions in thepatient.

The laparoscopic and NOTES surgical device of the present inventionserves as a general-purpose platform to which a variety of surgicaldevices can be attached, controlled and positioned independently by thesurgeon. Depending on the size, shape and type of laparoscopic and NOTESsurgical device a variety of surgical methods may be used includinginsertion through an incision and or a trocar. In particular, the NOTESsurgical devices may be introduced via a natural orifice (e.g., mouth,anus, vagina, etc) and navigated to a suitable location therein.

Laparoscopic and NOTES surgical devices that are inserted through thetrocar or overtube are constrained to the size of the access port, e.g.,must be collapsible to clear the minimal cross section of the accessport for insertion; this is typically accomplished through pin jointswhich also allow for relative link motion when coupled to two externalanchors. The magnetically-coupled surgical device may also be capable ofself-actuation, e.g., self-actuating scissors, graspers, hook cautery,and fine-scan motion cameras. Unlike the recent generation oflaparoscopic surgical robots however, the laparoscopic and NOTESsurgical devices of the present invention neither require, nor arelimited, by the standard working envelope of a dedicated trocar port.

The present invention provides a laparoscopic and NOTES surgicalelectro-cautery device body having a first side and a second side. Thefirst side includes an anchoring and positioning mechanism and thesecond side includes an electro-cautery surgical mechanism. Generally,disposed in or about the laparoscopic and NOTES device body is ananchoring and positioning mechanism having a magnetic region and/or aferrous region and a camera and/or a light. The electro-cautery surgicalmechanism includes an electro-cautery tip positioned on a moveableextension and includes a pivot mechanism, a rotation mechanism, aflexible shaft or combination thereof. A magnet or ferrous material ispositioned externally from the electro-cautery surgical device that iswithin a body cavity or hollow viscus, wherein manipulation of themagnet directs movement of the device within the body cavity or hollowviscus.

The present invention also provides a laparoscopic and NOTES surgicalretention, clamp or “gripper” device. The laparoscopic and NOTESsurgical retention device includes a device body having a first side anda second side. The first side includes an anchoring and positioningmechanism and the second side including a retention device having one ormore movable members. The one or more movable members are used to graspan item. The retention device includes a moveable extension, a pivotmechanism, a rotation mechanism, a flexible shaft or combinationthereof. The retention device is internally powered, externally powered,or combination thereof.

In addition, a laparoscopic and NOTES surgical needle device is providedby the present invention. The laparoscopic and NOTES device bodyincludes a first side having an anchoring and positioning mechanism anda second side having a needle positioned in a needle driving device,wherein the needle has a lumen. The needle driving device includes amoveable extension, a pivot mechanism, a rotation mechanism, a flexibleshaft or combination thereof and may be internally powered, externallypowered, or combination thereof. The device also includes an insertionrod moveably positioned in the lumen, wherein the insertion rod extendsthrough the hole created by the needle and into the interior of theopening.

A laparoscopic and NOTES surgical vacuum cup device is also provided.The laparoscopic and NOTES surgical vacuum cup device has a first sideand a second side. The first side includes an anchoring and positioningmechanism and the second side includes a vacuum cup extension on orabout a telescopic arm or structure connected to a vacuum cup. Thevacuum cup extension includes a pivot mechanism, a rotation mechanism, aflexible shaft or combination thereof. Generally, the vacuum cup isconnected to a vacuum source.

In addition, the present invention provides a method of using thelaparoscopic and NOTES surgical devices discloses herein. Thelaparoscopic and NOTES surgical device is positioned within a cavity orhollow viscus and secured in position. The laparoscopic and NOTESsurgical device is then activated. The laparoscopic and NOTES surgicaldevice may be a laparoscopic and NOTES electro-cautery surgical device,a laparoscopic and NOTES surgical retention device, a laparoscopic andNOTES surgical needle device, a laparoscopic and NOTES surgical vacuumcup device or a combination thereof.

FIG. 1 is an isometric view of one embodiment of the laparoscopic andNOTES cautery device 10 of the present invention and includes two padopenings 12 in relation on top surface 14. In this figure, the two padopenings 12 do not extent through the top surface 14; however, otherembodiments may include pad openings 12 that extent through the topsurface 14. In addition, pad openings 12 may vary in number (e.g., 1, 3,4, 5, 6, 7, 8, 9, 10 or more), size/shape (e.g., linear, parallel,square, oval, round or combinations thereof) and location in the topsurface 14, side surface 16 or bottom surface (not shown). Thelaparoscopic and NOTES cautery device 10 includes a pivotable lever 18connected to the cautery unit 20 having a cautery tip 22.

While depicted as pad openings 12, the pad openings 12 are provided toadd, when required, one or more mechanical attachment inserts. When usedwith suction, the pad openings may remain as openings. Examples ofinserts that may be placed in the pad openings 12 include, but are norlimited to, ferrous materials, magnetic materials, pin holders, suctioncups, hook and loop structures, hooks, one or more pins, retractableattachments (hooks, pins and combinations thereof), hydrophilicmaterials, hydrophobic materials, beads, reservoirs, gel-like materials,a mechanical trap (e.g., a biaxial locking mechanism), and combinationsthereof.

In certain embodiments, magnets may be placed in the pad openings 12 tosecure or move or position the laparoscopic and NOTES devices. Themagnets may be permanent magnets generating a magnetic field of aconstant strength. In other embodiments, the magnetic field may be anelectromagnetic field having a constant strength, a variable strength,or a varying time-dependent strength. Magnetic fields for use with thepresent invention may be single magnetic sources, or may be composed ofarrays of smaller sources. In one embodiment, the pads are magnetic padsthat are attracted to a ferrous material external to the lumen, e.g., asingle attachment point on a stand, a wire or even a three-dimensionalcover that is positioned over the surgical subject or patient. Inanother embodiment, the pads are ferrous materials that are attracted toa magnetic material external to the lumen. In yet another embodiment,both the laparoscopic and NOTES device and the external positioningand/or attachment point are magnetic.

The laparoscopic and NOTES device may be made in part or entirely of oneor more materials, e.g., surgical plastic, stainless steel, aluminum,titanium, nylon, polyester or other polymeric materials, alloys, andmixtures and combinations thereof. The components of the presentinvention may be made of a unitary construction using, e.g., molding,milling and the like. With any of the present inventions thelaparoscopic and NOTES device body may be of any shape (e.g., spherical,rectangular, cubical, freeform) or dimension desired and not limited tothe specific shape or structure disclosed herein. Furthermore, thedevice may be coated with or deliver active agents to a specificlocation, e.g., anti-microbial, anti-inflammatory, pain reducing ornumbing agents.

FIG. 2 is another isometric view of one embodiment of the laparoscopicand NOTES cautery device 10 of the present invention illustrating acamera 24 and a illumine device 26 in relation on the bottom surface 28and the side surface 16. The laparoscopic and NOTES cautery device 10includes a pivotable lever 18 extending from the bottom surface 28 andconnected to the cautery tip 22. The pivotable lever 18 may pivot aboutthe axel 30 to position the cautery tip 22 for cauterization. Thispositioning may be aided by the use of the camera 24 and the illuminedevice 26. In addition, the laparoscopic and NOTES cautery device 10 maybe connected to a power supply (not shown), an imaging device (notshown), a display (not shown), a fiber optic (not shown), control device(not shown) or combination thereof with a cable (not shown), wire (notshown), optical cable (not shown), fiber optic (not shown) orcombination thereof. In addition, the laparoscopic and NOTES cauterydevice 10 may include internal power, external power, inductive power ora combination thereof.

FIG. 3 is another isometric view of one embodiment of the laparoscopicand NOTES cautery device 10 of the present invention. The laparoscopicand NOTES cautery device 10 includes a camera 24 and a illumine device26 in relation on the bottom surface 28 and the side surface 16. Thelaparoscopic and NOTES cautery device 10 includes a pivotable lever 18connected to cautery tip 22. The pivotable lever 18 may pivot about theaxle 30 to position the cautery tip 22 for cauterization. Thispositioning may be aided by the use of the onboard camera 24 and theillumine device 26. In addition, the laparoscopic and NOTES cauterydevice 10 may be connected to a power supply (not shown), an imagingdevice (not shown), a display (not shown), a fiber optic (not shown),control device (not shown), a pneumatic source (not depicted) orcombination thereof through a cable (not shown), wire (not shown),optical cable (not shown), fiber optic (not shown) or combinationthereof. In addition, the laparoscopic cautery device 10 may includeinternal power, external power, inductive power or a combinationthereof.

Generally, the laparoscopic and NOTES cautery device 10 is a relativelysmall medical instrument used for searing tissue or wounds to reducebleeding, e.g., electrocautery. The localized temperature at the tip mayreach approximately 1000° C. in some instances; however, othertemperatures are also acceptable. The laparoscopic and NOTES cauterydevice 10 may be powered by an internal source, connected to an externalsource, coupled to a source that induces power or a combination thereof.The laparoscopic and NOTES cautery device 10 includes a cautery tip 22that may be made of a variety of materials (e.g., platinum-iridiumalloy), various lengths and diameters (e.g., 0.05 mm to 0.2 mm to 5 mmin diameter) and various orientations (e.g., straight tip, angled tip,etc.) known to the skilled artisan.

FIG. 4 is an isometric view of one embodiment of the laparoscopic andNOTES surgical retention device 40 of the present invention having twopad openings 12 in relation on the top surface 14. Generally, the twopad openings 12 do not extent through the top surface 14 to the bottomsurface (not shown); however, other embodiments may include pad openings12 that extent through the top surface 14 or are tapered in shaped tofrictionally fit one or more magnetic or ferrous materials (not shown)and/or vacuum plenums. In addition, pad openings 12 may vary in number(e.g., 1, 3, 4, 5, 6, 7, 8, 9, 10 or more), size/shape (e.g., linear,parallel, square, oval, round or combination thereof) and location inthe top surface 14, the side surface 16 or the bottom surface (notshown). The laparoscopic and NOTES surgical retention device 40 includesa pivotable lever 18 extending from the bottom surface 28 and connectedto a retention extension 42 and a moveable piston 44 that may move inand out of the retention extension 42 to extend the range of movement ofthe retention mechanism 46 positioned at the one end of the moveablepiston 44. The retention mechanism 46 includes a first arm 48 and asecond arm 50 positioned movably thereon. The first arm 48 and secondarm 50 may be used to close around an object, e.g., a vein, an organ, aforeign body and so forth. In some embodiments, the retention mechanism46 is controlled remotely by the operator; however, in otherembodiments, the retention mechanism 46 is self actuating usingactivator 52. Upon contact with the activator 52, the first arm 48 andsecond arm 50 close to secure the object.

FIG. 5 is isometric view of one embodiment of the laparoscopic and NOTESsurgical retention device 40 of the present invention illustrating acamera 24 and an illumine device 26 in relation on the bottom surface 28and the side surface 16. The laparoscopic and NOTES surgical retentiondevice 40 includes a pivotable lever 18 extending from the bottomsurface 28 and connected to a retention extension 42 and a telescopicstructure 44 that may move in and out of the retention extension 42 toextend the range of movement of the retention mechanism 46 positioned atone end of the moveable telescopic structure 44. The retention mechanism46 includes a first arm 48 and a second arm 50 movably positionedthereon. The first arm 48 and second arm 50 may be used to close aroundan object, e.g., a vein, an organ, a foreign body and so forth. In someembodiments, the retention mechanism 46 is self-actuating usingactivator 52. Upon contact with the activator 52 the first arm 48 andsecond arm 50 are closed to secure the object. The positioning of theretention mechanism 46 may be aided by the camera 24 and the illuminedevice 26. In addition, the laparoscopic and NOTES surgical retentiondevice 40 may be connected to a power supply (not shown), an imagingdevice (not shown), a display (not shown), a fiber optic (not shown),control device (not shown) or combination thereof with a cable (notshown), wire (not shown), optical cable (not shown), fiber optic (notshown), a pneumatic source (not depicted) or combination thereof. Inaddition, the laparoscopic and NOTES surgical retention device 40 mayinclude internal power, external power connection, inductive power or acombination thereof.

FIG. 6 is another isometric view of one embodiment of the laparoscopicand NOTES surgical retention device 40 of the present inventionillustrating a camera 24 and a illumine device 26 in relation on thebottom surface 28 and the side surface 16. The laparoscopic surgicalretention device 40 includes a pivotable lever 18 connected to aretention mechanism 46. The pivotable lever 18 may pivot about the axle30 to position the retention mechanism 46 at the proper position tosecured or retract an object. The retention mechanism 46 includes aretention extension 42 and a moveable piston 44 to extend the range ofmovement. The retention mechanism 46 includes a first arm 48 and asecond arm 50 movably positioned thereon to close around an object,e.g., a vein, an organ, a foreign body and so forth. In someembodiments, the retention mechanism 46 is self-actuating usingactivator 52. Upon contact with the activator 52 the first arm 48 andsecond arm 50 close to secure the object.

The retention extension 42 and moveable telescopic structure 44 areconfigured to move and provide extension of the retention mechanism 46.The mechanism that causes the retention extension 42 and moveabletelescopic structure 44 to retract or extend may be any mechanism knownin the art. For example, the retention extension 42 can be used toposition the retention mechanism 46 to the desired location by themoveable telescopic structure 44 to extend/retract the retentionmechanism 46. In some instances, the mechanism is moved by pneumaticpower (e.g., pneumatic piston), an electric motor, a gear mechanism andsimilar devices known to the skilled artisan. In addition toextending/retracting, the mechanism may pivot or rotate independently.Furthermore, the retention extension 42 and or the moveable telescopicstructure 44 may be flexible, e.g., polymer, spring, wire, filament,elastic or other material known to the skilled artisan.

The first arm 48 and second arm 50 may be closed by a mechanical orpneumatic source that directly moves the first arm 48 and second arm 50together. In other embodiments, the source that moves the first arm 48and second arm 50 is mechanical electrical, hydraulic or other knownsource of power. In some embodiments, the first arm 48 and second arm 50are closed by a mechanical activator 52 or an optical trigger. It is notnecessary that both arms move as the movement of a single arm may graspon object against a stationary arm. The number of arms (e.g., 2, 3, 4,5, 6 or more) may be varied depending on the application. In addition,the first arm 48 and second arm 50 may be of similar or differentlengths, widths, diameters, shapes, materials and so forth. In some,instances, the retention mechanism 46 may be a clamp, a retractor or acombination thereof, e.g., 2 arms to function as a retractor and 2 armsto clamp.

FIG. 7 is an isometric view of one embodiment of the laparoscopic andNOTES surgical needle device 70 of the present invention illustratingtwo pad openings 12 in relation on the top surface 14. Generally, thetwo pad openings 12 do not extent through the top surface 14 to thebottom surface (not shown); however, other embodiments may include padopenings 12 that do extent through the top surface 14 or are tapered inshape to frictionally fit magnetic and/or ferrous materials (not shown)and/or vacuum plenums. In addition, the pad openings 12 may vary innumber (e.g., 1, 3, 4, 5, 6, 7, 8, 9, 10 or more), size/shape (e.g.,linear, parallel, square, oval, round or combination thereof) andlocation (e.g., the top surface 14, the side surface 16 or the bottomsurface). The laparoscopic and NOTES surgical retention device 40includes a pivotable lever 18 extending from the bottom surface (notshown) and connected to a piercing mechanism 72. The piercing mechanism72 includes a driving mechanism 74 which can extend and retract a needle76. The needle 76 may be solid, hollow or include an insertion rod 78which may be extended through the needle lumen and hole created by theneedle 76. In some embodiments, an object may be connected to theinsertion rod 78 for insertion into the interior of the opening, e.g., aballoon (80), t-fastener, clip (not shown) or fish-hook shaped device(not shown) and the needle 76 retracted.

FIG. 8 is isometric view of one embodiment of the laparoscopic and NOTESsurgical needle device 70 of the present invention showing a camera 24and a illumine device 26 in relation on bottom surface 28 and sidesurface 16. The laparoscopic and NOTES surgical needle device 70includes a pivotable lever 18 extending from the bottom surface 28 andconnecting to a piercing mechanism 72 that includes a driving mechanism74, which can extend and retract a needle 76. The needle 76 may besolid, hollow or include an insertion rod 78 which may be extendedthrough the hole created by the needle 76 into the interior of theopening. In some embodiments, an object may be connected to theinsertion rod 78 and inserted into the opening, e.g., a balloon (80),t-fastener, clip (not shown) or fish-hook shaped device (not shown) isadvanced into the organ and then the needle 76 is retracted. Thepositioning of the retention mechanism 46 may be aided by the use of thecamera 24 and the illumine device 26. In addition, the laparoscopic andNOTES surgical needle device 70 may be connected to a power supply (notshown), an imaging device (not shown), a display (not shown), a fiberoptic (not shown), control device (not shown) or combination thereofthrough a cable (not shown), wire (not shown), optical cable (notshown), fiber optic (not shown), a pneumatic source (not depicted) orcombination thereof. In addition, the laparoscopic and NOTES surgicalneedle device 70 may include internal power, external power connection,inductive power or a combination thereof.

FIG. 9 is another isometric view of one embodiment of the laparoscopicand NOTES surgical needle device 70 of the present invention with acamera 24 and a illumine device 26 in relation on the bottom surface 28and the side surface 16. The laparoscopic and NOTES surgical needledevice 70 includes a pivotable lever 18 connected to a piercingmechanism 72 that includes a driving mechanism 74, which can extend andretract the needle 76. The needle 76 may be solid, hollow or include aninsertion rod 78 which may be extended through the hole created by theneedle 76 and into the opening. In some embodiments an object may beconnected to the insertion rod 78 and inserted into the opening, e.g., aballoon (80), t-fastener, clip (not shown) or fish-hook shaped device(not shown) is advanced into the organ and then the needle 76 isretracted.

The driving mechanism 74 that slides or extends the needle 76 may be anymechanism known in the art. For example, the driving mechanism 74 canalso be used to position the needle 76 to the desired location. Thepiercing mechanism 72 may be as simple as a spring-loaded mechanism, apneumatic mechanism (e.g., pneumatic piston), an electric motor, a gearmechanism and similar devices known to the skilled artisan that can beused to extend the needle 76 into a tissue.

The needle 76 may be expelled from the driving mechanism 74 and theinsertion rod 78 may pass through the needle 76 and through thepuncture. The insertion rod 78 may be extended through a simplespring-loaded mechanism, a pneumatic mechanism (e.g., pneumatic piston),an electric motor, a gear mechanism and similar devices known to theskilled artisan that can be used to extend the insertion rod 78 into theaperture created by the needle 76.

FIG. 10 is an isometric view of one embodiment of the laparoscopic andNOTES vacuum cup device 100 of the present invention. The laparoscopicand NOTES vacuum cup device 100 includes two pad openings 12 in relationon top surface 14. Generally, the two pad openings 12 do not extentthrough the top surface 14 to the bottom surface (not shown); however,other embodiments may include pad openings 12 that do extent through thetop surface 14 or are tapered in shape to frictionally fit magneticand/or ferrous materials (not shown) and/or vacuum plenums. In addition,the pad openings 12 may vary in number (e.g., 1, 3, 4, 5, 6, 7, 8, 9, 10or more), size/shape (e.g., linear, parallel, square, oval, round orcombination thereof) and location in the top surface 14, the sidesurface 16 or the bottom surface (not shown). The laparoscopic vacuumcup device 100 includes a pivotable lever 18 extending from the bottomsurface (not shown) and connected to a vacuum cup extension 42 and themoveable telescopic structure 44 that may move into and out of thevacuum cup extension 42 to extend the range of movement of the vacuumcup 102 positioned at the one end of the moveable telescopic structure44. The vacuum cup 102 is positioned against/on or near an object, e.g.,vein, organ, foreign body and so forth. The vacuum is applied to thevacuum cup 102 to attach thereto or to remove fluids, solids orcombinations thereof. In some embodiments, the vacuum is applied by anexternal source; however, in other embodiments the vacuum is applied byan internal source. The positioning of the vacuum cup 102 may be aidedby the use of the camera 24 and the illumine device 26. In addition, thelaparoscopic vacuum cup device 100 may be connected to a power supply(not shown), an imaging device (not shown), a display (not shown), afiber optic (not shown), control device (not shown) or combinationthereof through a cable (not shown), wire (not shown), optical cable(not shown), fiber optic (not shown), a pneumatic source (not depicted)or combination thereof. In addition, the laparoscopic and NOTES surgicalretention device 40 may include internal power, external powerconnection, inductive power or a combination thereof.

FIG. 11 is isometric view of one embodiment of the laparoscopic andNOTES vacuum cup device 100 of the present invention illustrates acamera 24 and a illumine device 26 in relation on bottom surface 28 andside surface 16. The laparoscopic and NOTES vacuum cup device 100includes a pivotable lever 18 extending from the bottom surface 28 andconnected to a vacuum cup extension 42 and moveable piston 44 that maymove into and out of the vacuum cup extension 42 to extend the range ofmovement of the vacuum cup 102 positioned at the one end of the moveabletelescopic structure 44. The vacuum cup 102 is positioned against/on ornear an object, e.g., vein, organ, foreign body and so forth. The vacuumis applied to the vacuum cup 102 to attach thereto or to remove fluids,solids or combinations thereof. In addition, the laparoscopic and NOTESvacuum cup device 100 may be connected to a power supply (not shown), animaging device (not shown), a display (not shown), a fiber optic (notshown), control device (not shown) or combination thereof through acable (not shown), wire (not shown), optical cable (not shown), fiberoptic (not shown), a pneumatic source (not depicted) or combinationthereof. In addition, the laparoscopic and NOTES vacuum cup device 100may include internal power, external power connection, inductive poweror a combination thereof.

FIG. 12 is another isometric view of one embodiment of the laparoscopicand NOTES vacuum cup device 100 of the present invention and includes acamera 24 and a illumine device 26 in relation on bottom surface 28 andside surface 16. The laparoscopic and NOTES vacuum cup device 100includes a pivotable lever 18 connected to a vacuum cup extension 42 andmoveable piston 44 that may move in and out of the vacuum cup extension42 to extend the range of movement of the vacuum cup 102 that ispositioned at the end of the moveable telescopic structure 44. Thevacuum cup 102 may be positioned against/on or near an object, e.g.,vein, organ, foreign body and so forth.

In some embodiments, the laparoscopic and NOTES device of the presentinvention includes two types of locking mechanisms for the pin having apin lock, such as that disclosed by the present inventors in U.S. PatentApplication US20050165449A1, relevant portions incorporated herein byreference. Briefly, the pin may have a sharpened point for traversing atissue. To hold the pin in place, a pin lock, in this embodiment a shaftand a lock pad are included. The laparoscopic and NOTES device includesan opening having a conical focal point at the bottom of the openingthrough which the pin is inserted to anchor the laparoscopic and NOTESdevice and having a locking arm that self-locks. The pin may haveserrations, which may be used to increase friction and thereby improvethe anchoring capacity of the laparoscopic and NOTES device. Anothervariation of the locking mechanism for the pin and laparoscopic andNOTES device is one in which the serrations thread into an internalthread. When using the laparoscopic and NOTES device, the position ofthe laparoscopic and NOTES device as the anchor site and then may lockthe anchor into position semi-permanently by inserting the pin into theself-locking mechanism.

In addition, the laparoscopic and NOTES devices of the present inventionmay include one or more pad openings 12 on the top surface 14. As willbe apparent from the current disclosure, additional openings and padopenings 12 may be added and positioned in a linear, parallel, square,oval, round, and/or in two and three-dimensions. In addition, the sizeand dimensions of the pad openings 12 may vary depending on theapplication. In fact, some embodiments may not have pad openings 12 atall, as the materials are incorporated into the laparoscopic and NOTESdevice itself. Alternatively, the laparoscopic and NOTES devices may beattached to larger structures that are secured or may be secured withsuction cups or pins. Thus allowing the laparoscopic and NOTES devicesto be positioned by manual manipulation, or may be positioned with thehelp of, e.g., a magnetic field.

The pivotable lever 18 is pivotably positioned in or about thelaparoscopic and NOTES devices so that the pivotable lever 18 may bemoved to the desired position. The pivotable lever 18 may includeattachments for manual, pneumatic, hydraulic, mechanical, electrical orother systems (including combinations thereof) to power the devices ofthe laparoscopic and NOTES device. In addition, the pivotable lever 18may include attachment mechanisms for different devices.

In one specific example, the laparoscopic and NOTES device of thepresent invention includes an anchoring mechanism to the abdominal lumenand includes a high-resolution charge-coupled device (CCD),complementary metal oxide conductor (CMOS) camera or even an analogcamera. The camera may be internally powered or externally powered.While the camera may obtain and transmit a signal independent of anexternal power source, the surgical anchor of the present invention mayalso provide electrical and optical contacts with the surgical toolattached to the surgical anchor. For example, a camera and light mayobtain, e.g., electrical power from the pin and be grounded via thepatient or a wire or pin. The wire or pin may be made of, or includes,optic fiber, a signal may be transmitted to and from the camera throughthe pin or the cable itself. The pin or the cable may even provideelectrical, mechanical, pneumatic, communications and the like to thesurgical tool via or around the surgical anchor and NOTES platform. Inanother embodiment, the camera delivers a signal via a radio frequencyor other transmission system and is wireless.

The sensitivity, reliability and simplicity of operation of the systemmay be evaluated by direct comparison to conventional images capturedusing conventional laparoscopic and endoscopic instruments. Other imagecapture systems may be used in conjunction with the imaging system. Forexample, fiber optic leads may be placed close to the image and theimage transferred for capture outside the body. In addition, wavelengthsoutside visible light may be captured by the imaging system.

Typically, an illuminating device 26 is required for a video system totransmit a signal for use in surgery. The cable may include additionalwires, optical fiber and pneumatic lines into, e.g., the abdominal areato provide command, control and electrical connections through theabdominal wall or hollow viscus without leaking gas out of the abdomen.The trocar cable and light port has one or more internal conduits thattraverse the length of the trocar cable and light port and through whichone or more cables, optic fiber and pneumatic lines may be inserted intothe patient, while at the same time maintaining access to theintraabdominal cavity and hollow viscus through the trocar and NOTESplatform.

FIG. 13A is a top view of a dual-magnet and FIG. 13B is cross-sectionalview of the dual magnet stack 110 for use with any of the laparoscopicand NOTES devices of the present invention made of, or including, amagnetically attracting material. The dual external magnet stack 110 hasa casing 112 having one or more magnet holding openings 114 thatgenerally will be small enough to be hand-held. Into each of the magnetholding openings 114 may be inserted a magnetic source in: N-S, S-N, S-Sor N-N orientation. In one embodiment, the magnet is an electromagnetand the strength and orientation of the field may be externallycontrolled by providing power to the electromagnet. The magnet holdingopenings 114 are depicted as cylindrical, however, they may have anyshape: oval, square, rectangular, etc. The holes 116 in the casing 112and may be used to attach the dual external magnet stack 110 to a standor holder. One particularly useful aspect of the dual external magnetstack 110 is that, when used in conjunction with the laparoscopic andNOTES surgical device 10 depicted in FIG. 1 having pads (not shown)included into pad openings 12 in the top surface 14. The dual externalmagnet stack 110 may be used to turn the laparoscopic surgical device 10about a range of 360 degrees, while magnetically coupling the each ofthe magnets of the dual stack to one of the pads (not shown).

FIG. 14 is a cross-sectional view combining the laparoscopic and NOTESsurgical device 10 and the dual external magnet stack 110 for use withthe present invention. FIG. 14 combines the dual external magnet stack110 having magnets 118 in the casing 112 with a laparoscopic and NOTESsurgical device 10. The laparoscopic and NOTES surgical device 10 isalso shown in cross-section and with the pad openings 12 containing thepads 120 that are of a magnetically attracting material. By using thecombination of the dual external magnet stack 110 with the pads 120 thatare of a magnetically attracting material, the laparoscopic surgicaldevice 10 may be rotated 360 degrees under the external control of thesurgeon by rotating the dual external magnet stack 110.

The laparoscopic and NOTES device of the present invention providesseveral distinct advantages over the use of conventional hand-heldlaparoscopic and endoscopic tools. First, it provides an independentanchor point for the attachment of one or more surgical tools,retractors, clamps, scalpels, cameras, lights and the like that areinserted once into the patient through a single trocar or naturalorifice. The laparoscopic and NOTES device may be anchored to the lumenof the body cavity or hollow viscus using external magnets or byinsertion of a single small pin, which may attached via, e.g., aself-locking mechanism, thereby providing a hands-free anchor point forother tools while also freeing-up the trocar for insertion of additionalanchors of providing for insertion of another working surgical tool.Second, one or more independent tools may be swapped between the anchorsto increase the functionality and flexibility of the system. Third, byusing magnetic positioning, the same surgical anchor may be moved fromlocation to location, again reducing the number of major incisions whileallowing maximum flexibility for tool use and positioning.

The laparoscopic and NOTES device for use with the present inventionwill generally be sized to be passable through an incision or a trocarport by a laparoscopic and NOTES grasper or forceps for attachment tothe surgical anchor. In some cases, it may be desirable for thelaparoscopic and NOTES device to be a camera, a camera with one or morelights (e.g., optic fibers), surgical retractors, e.g., a retractor, asling retractor, a paddle retractor, a clamp, a basket, a bag, a hookand the like, a cutting tool, e.g., a laser or a scalpel, or even asuction tube for removal of tissue. The laparoscopic and NOTES devicemay include a hook or other locking mechanism that is complementary withan anchor point. The laparoscopic and NOTES device may be formed ofmetal, plastic, combination of metal and plastics or other suitablematerial. The surgical tool may also include drawstrings to help removethe surgical tool through the trocar or other opening after use.

It will be understood that particular embodiments described herein areshown by way of illustration and not as limitations of the invention.The principal features of this invention can be employed in variousembodiments without departing from the scope of the invention. Thoseskilled in the art will recognize, or be able to ascertain using no morethan routine experimentation, numerous equivalents to the specificprocedures described herein. Such equivalents are considered to bewithin the scope of this invention and are covered by the claims.

All publications and patent applications mentioned in the specificationare indicative of the level of skill of those skilled in the art towhich this invention pertains. All publications and patent applicationsare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

In the claims, all transitional phrases such as “comprising,”“including, ” “carrying,” “having,” “containing,” “involving,” and thelike are to be understood to be open-ended, i.e., to mean including butnot limited to. Only the transitional phrases “consisting of” and“consisting essentially of,” respectively, shall be closed orsemi-closed transitional phrases.

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of “one or more,” “at least one,”and “one or more than one.” The use of the term “or” in the claims isused to mean “and/or” unless explicitly indicated to refer toalternatives only or the alternatives are mutually exclusive, althoughthe disclosure supports a definition that refers to only alternativesand “and/or.” Throughout this application, the term “about” is used toindicate that a value includes the inherent variation of error for thedevice, the method being employed to determine the value, or thevariation that exists among the study subjects.

The term “or combinations thereof” as used herein refers to allpermutations and combinations of the listed items preceding the term.For example, “A, B, C, or combinations thereof” is intended to includeat least one of: A, B, C, AB, AC, BC, or ABC, and if order is importantin a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB.Continuing with this example, expressly included are combinations thatcontain repeats of one or more item or term, such as BB, AAA, MB, BBC,AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan willunderstand that typically there is no limit on the number of items orterms in any combination, unless otherwise apparent from the context.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit and scope of the invention. More specifically, it will beapparent that certain agents which are both chemically andphysiologically related may be substituted for the agents describedherein while the same or similar results would be achieved. All suchsimilar substitutes and modifications apparent to those skilled in theart are deemed to be within the spirit, scope and concept of theinvention as defined by the appended claims.

1. A surgical electro-cautery device comprising: a device body; a firstmagnetic or ferrous material in a first portion of the device body; asecond magnetic or ferrous material in a second portion of the devicebody, the first and second portions of the device body being spacedapart from each other; and an electro-cautery surgical mechanism coupledto the device body, the electro-cautery surgical mechanism including arotation mechanism.
 2. The device of claim 1, wherein the device bodyfurther comprises, a suction region.
 3. The device of claim 1, furthercomprising a camera, a light or combination thereof disposed in or aboutthe device body.
 4. The device of claim 1, wherein the electro-cauterysurgical mechanism comprises a straight electro-cautery tip positionedon a moveable extension.
 5. The device of claim 1, wherein theelectro-cautery surgical mechanism comprises a flexible shaft.
 6. Thedevice of claim 1, wherein the electro-cautery surgical mechanism isinternally powered, externally powered, or a combination thereof.
 7. Thedevice of claim 1, wherein the electro-cautery surgical mechanism ishydraulically or pneumatically powered.
 8. The device of claim 1,further comprising a drawstring for removing the device.
 9. The deviceof claim 1, wherein the device body comprises a surgical plastic. 10.The device of claim 1, further comprising a casing comprising a firstmaterial and a second material, the first and second materials beingconfigured and positioned to magnetically couple to the first and secondmagnetic or ferrous materials in the device body such that the positionof the device body within a body cavity or viscus can be changed bymanipulating the casing outside the body cavity or viscus.
 11. Asurgical electro-cautery device comprising: a device body; a firstmagnetic or ferrous material in a first portion of the device body; asecond magnetic or ferrous material in a second portion of the devicebody, the first and second portions of the device body being spacedapart from each other; and an electro-cautery surgical mechanism coupledto the device body, the electro-cautery surgical mechanism having astraight electro-cautery tip.
 12. The device of claim 11, furthercomprising a casing comprising a first material and a second material,the first and second materials being configured and positioned tomagnetically couple to the first and second magnetic or ferrousmaterials in the device body such that the position of the device bodywithin a body cavity or viscus can be changed by manipulating the casingoutside the body cavity or viscus.
 13. The device of claim 11, furthercomprising a camera, a light or combination thereof disposed in or aboutthe device body.
 14. The device of claim 11, wherein the electro-cauterysurgical mechanism comprises a flexible shaft.
 15. The device of claim11, wherein the electro-cautery surgical mechanism is internallypowered, externally powered, or a combination thereof.
 16. The device ofclaim 11, wherein the electro-cautery surgical mechanism ishydraulically or pneumatically powered.
 17. The device of claim 11,further comprising a drawstring for removing the device.
 18. The deviceof claim 11, wherein the device body comprises a surgical plastic.
 19. Asurgical electro-cautery device comprising: a device body having aleading end a trailing end; a first magnetic or ferrous material in afirst portion of the device body; a second magnetic or ferrous materialin a second portion of the device body, the first and second portions ofthe device body being spaced apart from each other; an electro-cauterysurgical mechanism coupled to the device body at a location nearer thetrailing end than the leading end; and a camera and a light coupled tothe device body at respective locations that are nearer the leading endthan the trailing end.
 20. The device of claim 19, further comprising acasing comprising a first material and a second material, the first andsecond materials being configured and positioned to magnetically coupleto the first and second magnetic or ferrous materials in the device bodysuch that the position of the device body within a body cavity or viscuscan be changed by manipulating the casing outside the body cavity orviscus.
 21. The device of claim 19, wherein the electro-cautery surgicalmechanism comprises a flexible shaft.
 22. The device of claim 19,wherein the electro-cautery surgical mechanism is internally powered,externally powered, or a combination thereof.
 23. The device of claim19, wherein the electro-cautery surgical mechanism is hydraulically orpneumatically powered.
 24. The device of claim 19, further comprising adrawstring for removing the device.
 25. The device of claim 19, whereinthe device body comprises a surgical plastic.